PMID- 22305834
OWN - NLM
STAT- MEDLINE
DCOM- 20120327
LR  - 20120206
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 163
IP  - 2
DP  - 2012 Feb
TI  - Efficacy and safety of enoxaparin compared with unfractionated heparin in the 
      pharmacoinvasive management of acute ST-segment elevation myocardial infarction: 
      Insights from the TRANSFER-AMI trial.
PG  - 176-81.e2
LID - 10.1016/j.ahj.2011.10.015 [doi]
AB  - AIMS: An early invasive strategy after fibrinolysis for ST-elevation myocardial 
      infarction (STEMI) improves outcomes, but the relative efficacy and safety of 
      enoxaparin compared with unfractionated heparin (UFH) as part of this approach 
      are unknown. METHODS AND RESULTS: In the TRANSFER-AMI trial, patients with 
      high-risk STEMI received fibrinolysis and were then randomized to either standard 
      treatment or to immediate transfer for coronary angiography. In this substudy, 
      the outcome of patients aged <75 years treated with enoxaparin is compared with 
      that of patients who received UFH. Logistic regression and propensity score 
      models were used to evaluate the efficacy and safety of these anticoagulants. 
      Enoxaparin was administered to 498 patients, and UFH, to 448 patients, at the 
      time of fibrinolysis. Approximately 50% in each group were randomized to the 
      early invasive strategy. The primary composite end point of death, reinfarction, 
      recurrent ischemia, new or worsening heart failure, or cardiogenic shock at 30 
      days occurred in 11.9% and 11.6% of the patients who received enoxaparin and UFH, 
      respectively (adjusted odds ratio 0.95 [95% CI 0.60-1.51], P = .84). Enoxaparin 
      use was associated with more access site bleeding (5.0% vs 2.9%, P = .04) and 
      mild bleeding (12.1% vs 7.8%, P = .03). CONCLUSIONS: Among high-risk patients 
      with STEMI undergoing early or late transfer for cardiac catheterization after 
      fibrinolysis, enoxaparin was associated with similar efficacy compared with UFH, 
      but there was more minor bleeding with enoxaparin (ClinicalTrials.gov no. 
      NCT00164190).
CI  - Copyright (c) 2012 Mosby, Inc. All rights reserved.
FAU - Lavi, Shahar
AU  - Lavi S
AD  - London Health Sciences Centre, Ontario, Canada.
FAU - Cantor, Warren J
AU  - Cantor WJ
FAU - Casanova, Amparo
AU  - Casanova A
FAU - Tan, Mary K
AU  - Tan MK
FAU - Yan, Andrew T
AU  - Yan AT
FAU - Dzavik, Vladimir
AU  - Dzavik V
FAU - Fitchett, David
AU  - Fitchett D
FAU - Cohen, Eric A
AU  - Cohen EA
FAU - Borgundvaag, Bjug
AU  - Borgundvaag B
FAU - Heffernan, Michael
AU  - Heffernan M
FAU - Ducas, John
AU  - Ducas J
FAU - Goodman, Shaun G
AU  - Goodman SG
LA  - eng
SI  - ClinicalTrials.gov/NCT00164190
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Canada/epidemiology
MH  - Dose-Response Relationship, Drug
MH  - *Electrocardiography
MH  - Enoxaparin/administration & dosage/*therapeutic use
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/therapeutic use
MH  - Follow-Up Studies
MH  - Heparin/administration & dosage/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*drug therapy/mortality
MH  - Survival Rate
MH  - Thrombolytic Therapy/*methods
MH  - Treatment Outcome
EDAT- 2012/02/07 06:00
MHDA- 2012/03/28 06:00
CRDT- 2012/02/07 06:00
PHST- 2011/07/13 00:00 [received]
PHST- 2011/10/21 00:00 [accepted]
PHST- 2012/02/07 06:00 [entrez]
PHST- 2012/02/07 06:00 [pubmed]
PHST- 2012/03/28 06:00 [medline]
AID - S0002-8703(11)00775-7 [pii]
AID - 10.1016/j.ahj.2011.10.015 [doi]
PST - ppublish
SO  - Am Heart J. 2012 Feb;163(2):176-81.e2. doi: 10.1016/j.ahj.2011.10.015.